经导管主动脉瓣置换术在 90 岁以上患者中的生活质量结局。

Quality of Life Outcomes After Transcatheter Aortic Valve Replacement in Nonagenarians.

机构信息

Tenet Florida, Boca Raton, FL 33431 USA.

出版信息

J Invasive Cardiol. 2020 Oct;32(10):375-379. doi: 10.25270/jic/20.00027.

Abstract

BACKGROUND

Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) is an increasingly prevalent treatment in patients who are intermediate or high risk for surgical intervention. In nonagenarian patients undergoing TAVR, symptomatic relief and quality of life (QoL) outcomes have not been well established. This study explores these outcomes in this patient population that has been underrepresented in landmark clinical trials.

METHODS

All patients who underwent TAVR between January 1, 2015 and December 31, 2018 at Delray Medical Center were included. The 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score was used to assess QoL prior to and 30 days following TAVR in two patient groups: the nonagenarian group (patients ≥90 years old) and the younger group (patients <90 years old). KCCQ-OS scores were compared between these two groups. Frailty assessment included grip strength, gait speed, and activities of daily living. Unadjusted and adjusted analyses (baseline KCCQ-OS score, frailty, and Society of Thoracic Surgery perioperative risk of mortality [STS-PROM] score) were performed to assess the impact of age on QoL outcomes in both groups.

RESULTS

Of the total 223 patients included in this study, a total of 46 (20.6%) were nonagenarians and 118 (52.7%) were men. KCCQ-OS scores were lower at baseline and 30-day follow-up in nonagenarians compared with the younger group (P=.70). Age was a significant predictor of 30- day KCCQ-OS in unadjusted and adjusted analyses (adjusted for baseline KCCQ-OS, frailty, and STS-PROM score). Nonagenarians had an average 6.45 points lower 30-day KCCQ-OS scores than the younger patients in adjusted analysis. However, there was a significant clinical improvement in the 30-day KCCQ-OS score in both groups (P<.001).

CONCLUSIONS

Our data suggest that with appropriate patient selection, a significant clinical improvement may be expected with TAVR in nonagenarians.

摘要

背景

经导管主动脉瓣置换术（TAVR）治疗严重主动脉瓣狭窄（AS）在中高危外科手术患者中越来越普遍。在接受 TAVR 的 90 岁以上患者中，症状缓解和生活质量（QoL）结果尚未得到充分证实。本研究旨在探讨这一在标志性临床试验中代表性不足的患者群体的结果。

方法

纳入 2015 年 1 月 1 日至 2018 年 12 月 31 日期间在德尔雷医疗中心接受 TAVR 的所有患者。采用 12 项堪萨斯城心肌病问卷总评（KCCQ-OS）评分，在两组患者（90 岁以上患者组和<90 岁患者组）中分别在 TAVR 术前和术后 30 天评估 QoL。比较两组间的 KCCQ-OS 评分。虚弱评估包括握力、步态速度和日常生活活动能力。进行了未调整和调整分析（基线 KCCQ-OS 评分、虚弱和胸外科手术协会围手术期死亡率风险评分[STS-PROM]），以评估年龄对两组 QoL 结果的影响。

结果

本研究共纳入 223 例患者，其中 46 例（20.6%）为 90 岁以上患者，118 例（52.7%）为男性。与年轻组相比，90 岁以上患者组的基线和术后 30 天 KCCQ-OS 评分较低（P=.70）。年龄是未调整和调整分析（调整基线 KCCQ-OS、虚弱和 STS-PROM 评分）中 30 天 KCCQ-OS 的显著预测因素。在调整分析中，90 岁以上患者组的 30 天 KCCQ-OS 评分比年轻患者组低 6.45 分。然而，两组患者的 30 天 KCCQ-OS 评分均有显著的临床改善（P<.001）。